General dentists are primary care providers trained and equipped to perform extractions. While complex extractions may require a referral to a specialist, the procedure is a common offering at most general dental offices. The distinction between routine and surgical procedures is based on the difficulty and specific location of the tooth being removed.
Scope of General Dentistry: Simple Tooth Removal
General dentists routinely handle extractions classified as “simple,” which involve teeth fully erupted and visible above the gum line. A simple extraction is typically performed when a tooth is severely decayed, damaged, or creating an overcrowding issue for orthodontic treatment. The procedure is relatively quick and usually requires only a local anesthetic to numb the area, ensuring the patient feels pressure but no sharp pain.
The dentist uses specialized instruments to perform the extraction with minimal trauma. An elevator is first employed to gently loosen the tooth from its socket by separating the periodontal ligament fibers. Once the tooth is sufficiently mobile, a dental forceps is used to firmly grasp the visible crown. The dentist then applies controlled pressure to remove the tooth from the alveolar bone.
Simple extractions are a fundamental skill of a general dental practitioner. Teeth with predictable root structures and those easily accessible are the usual candidates. The straightforward nature of the extraction allows for a shorter recovery time and less post-operative discomfort.
When Referral to an Oral Surgeon is Necessary
A general dentist will refer a patient to an Oral and Maxillofacial Surgeon (OMS) when the extraction is classified as “surgical,” indicating a higher level of complexity. This type of procedure is necessary when the tooth has not fully erupted, is impacted, or is broken off at or below the gum line. Teeth with complex, curved, or multi-rooted structures also often require surgical intervention for safe removal.
Surgical extractions frequently involve making a small incision in the gum tissue to fully access the tooth or surrounding bone. The surgeon may need to remove a small amount of jawbone or divide the tooth into smaller sections to allow for its safe removal. Patients with underlying medical conditions, such as severe bleeding disorders or those requiring advanced sedation, are also typically referred to an OMS.
Oral and Maxillofacial Surgeons (OMS) complete a minimum of four years of rigorous, hospital-based surgical residency training after dental school. This specialized training provides them with expertise in managing complex surgical cases and administering all forms of sedation, including general anesthesia. Their advanced surgical skill set makes them the appropriate specialist for complicated dental extractions.
Managing Immediate Post-Extraction Recovery
After the tooth is extracted, the dentist will place a sterile gauze pad over the socket, instructing the patient to maintain firm pressure for approximately 30 to 60 minutes to help a blood clot form. This clot is a natural biological dressing that protects the underlying bone and nerve endings, ensuring a smooth healing process.
Discomfort is expected as the local anesthetic wears off, and pain can typically be managed with prescribed medication or over-the-counter pain relievers. It is important to avoid creating any suction in the mouth during the first 24 to 48 hours; this means avoiding the use of straws, spitting, and smoking, as these actions can dislodge the blood clot and lead to a painful condition known as dry socket. Patients should stick to a diet of soft foods and liquids, avoiding hard, crunchy, or hot items that could irritate the surgical site. After the first day, gentle rinsing with a warm salt water solution can help keep the area clean without disturbing the clot.